NUR 514 Consider the evolution of the U.S. health care system
NUR 514 Consider the evolution of the U.S. health care system
NUR 514 Consider the evolution of the U.S. health care system
The contemporary healthcare structure focuses on patient-centeredness. It also focuses on career fulfillment and advancement for all practitioners. According to Bradley et al. (2018), contemporary healthcare further recognizes that disease and wellness co-exist. Thus, health is considered a dynamic quality state where the mind, body, and spirit are fully functional. The profession and all participants aim at enhancing patients’ versatile roles. Souliotis (2016) highlights that the current healthcare definition recognizes patients’ efforts and contributions toward their wellness. By engaging in decision-making, patients exercise their autonomous right by demanding high-quality and satisfactory services. Advanced practice registered nurses provide patient-centered direct services to enhance patient wellness. They offer direct and specialized healthcare services. Upholding patient-centeredness for patients means that APRNs offer culturally-competent care.
Practice for educators, public health professionals, informaticists, leaders, and administrators focus on offering support for patients and other nurses. Educators ensure that all stakeholders have crucial knowledge for treatment procedures. Dumit (2017) states that with the current technological advances and policy reforms, continuing education is crucial for practitioners. Informaticists ensure competence with the technology used to support patient care. On the other hand, leaders and administrators set and implement policies that guide nurse practitioners in offering the best care and having fulfilling careers.
However, irrespective of the differences in practice structures of the two categories, the patient is at the center of practice in all cases. The central theme is life fullness and wellness. The health issue is observational and focuses on the individual (Bradley et al., 2018). Even with chronic illnesses, individuals can still be healthy, and nurses are satisfied with their role and contributions to societal wellness. With the contemporary system, all healthcare stakeholders are open to learning and having new experiences.
References
Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a contemporary definition of health. Military medicine, 183(suppl_3), 204-207.
Dumit, N. (2017). Role of the nurse as educator: Patient teaching. Revue de Rescherche Scientifique de L’UniversitéAntonine, 6, 61-69.
Souliotis, K. (2016). Patient participation in contemporary health care: promoting a versatile patient role. Health Expectations: an International Journal of Public Participation in Health Care and Health Policy, 19(2), 175.
The healthcare delivery structure is influenced by political climate, economic development, technology, social and cultural values, environment, demographics, and global influences. The US healthcare delivery system has shifted it’s focus from illness to wellness, acute to primary care, individual to community well-being, fragmented to managed care, independent to integrated systems, and from duplication to a continuum of services. These trends were driven by the goal of promoting health while reducing the cost of healthcare. Thus midlevel health professionals and health coaches complement medical professionals to improve the effectiveness and efficiency of care. Physicians, advanced practice nurses, therapist, and other healthcare professionals may understand their own clinical role but not the forces outside their profession which may significantly affect current and future clinical practice, thus the promotion of interprofessional education and collaboration. (DeNisco, 2021)
Advanced practice registered nurses such as nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist are seeking to expand their scope of practice to be independent practitioners, with regulatory requirements and without direct supervision. Advanced nurse practitioners such as clinical nurse leaders and educators seek to better evaluate the implications of healthcare policies, and understand relevant issues and how they link to healthcare delivery services.
References:
DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning
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In just the past two years the United states healthcare system along with many healthcare systems all over the world have shifted and evolved overnight as a direct result of the COVID-19 pandemic. as a nation we came through to the realization that our healthcare system it’s still very vulnerable despite all of the strides made in technology medical technology and advancements in patient care, disease prevention and treatment. The pandemic also highlighted many of the public health issues that many Americans face. Our healthcare system was revealed to have poor patient care outcomes in addition to the revelation of just how sick many Americans are. Our health care system is in desperate need of revamping in regards to how we treat patients and their illnesses and improving their health outcomes. Many Americans are suffering with chronic health issues that are fueling hospital costs and in some cases draining our healthcare resources and creating longer wait times in emergency rooms. The COVID-19 pandemic showed just how vulnerable our healthcare system is and expose many of its weaknesses as well. There has been a shift to improving patient health outcomes by focusing on more holistic approaches and the patient as a whole. In addition to that there has been a push since the Affordable Care Act to implement more value based healthcare initiatives. “Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes” (NEJM Catalyst, 2017). The value based healthcare model is now pushing for better outcomes an efficient and effective care for patients. The value based healthcare model is striving to have patients spend less money to achieve better health provide efficiency and greater patient satisfaction put the control of cost back into the pairs slash patients hands reduce recidivism rates for suppliers to align their prices with patients outcomes and overall improving the societies health (NEJM, 2017). advanced nurses will be on the front lines in working with communities and patients to improve upon their health outcomes by also reinforcing health education, guiding people to health care resources, going into communities that are vulnerable and lack healthcare resources, helping people find resources for disease prevention and treatment as well as developing strong reports and visibility within communities especially those that are experiencing poverty and hospital and clinic desserts.
Reference:
NEJM Catalyst. (2017). What Is Value-Based Healthcare?. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558
I completely agree that our healthcare system needs revamping, and the major problem that our current system has created with health inequality. Working at a large health care system in North Phoenix, we help serve nearby Native American Tribes such as the Navajo tribe. The Navajo Nation experiences a large number of health disparities due to isolation/remoteness of areas with a lack of transportation (no paved roads or public transportation), lack of government healthcare funding, lack of infrastructure (clean water, plumbing, electricity, and many lack telecommunications), and limited opportunities for education (Nez, 2020). When patients from the Navajo Nation require a higher level of care in an acute care setting, they are often flown to a hospital far from the reservation and become isolated from their families with limited communication capabilities. Being a leader in the acute care setting, we can look for opportunities to help provide resources to the Navajo nation. For example, being able to send a multi-disciplinary team composed of nurse practitioners, RN’s, providers, dietitians, pharmacists, and respiratory therapists to set up temporary clinics that focus on health education and prevention and help with the management of chronic diseases (i.e., diabetes, heart disease, etc.). While caring for Native American patients in the hospital, it is critical to provide the medical care team with the tools to communicate and with an understanding of their culture in order to provide information and support making informed decisions. The Office of Minority Health has provided a set of standards to adapt care to accommodate language and culture (DeNisco, 2021). The OHM has taken a step to help recognize cultural differences and the importance of providing culturally competent care. The Navajo Nation is an example of where the U.S. health system has failed and created health inequality by not eliminating poverty and not providing safe living environments, infrastructure, and access to health care.
Global perspectives and diversity issues in healthcare have helped create an understanding of health equity in areas of poverty like the Navajo Nation. The top 25 wealthiest nations, excluding the U.S, offer a form of universal healthcare coverage. Access to healthcare is considered a basic human right (DeNisco, 2021). A study by the RWJF shows the power of eliminating health disparities would significantly decrease healthcare costs (Braveman et al., 2019). These examples emphasize the importance of equal healthcare access for all communities in the US.
References
Braveman, P., Gottlieb, L., Francis, D., Arkin, E., & Arcker, J. (2019, November 12). What can the health care sector do to advance health equity? Robert Wood Johnson Foundation. Retrieved September 24, 2022, from https://www.rwjf.org/en/library/research/2019/11/what-can-the-health-care-sector-do-to-advance-health-equity.html
DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124
Nez, J. (2020, July 17). The Navajo Nation – United States Commission on civil rights. U.S Commission of Civil Rights. Retrieved September 25, 2022, from https://www.usccr.gov/files/2020/2020-07-17-Jonathan-Nez-Testimony.pdf
According to DeNisco (2021), a major feature of the U.S. healthcare system is its fragmented nature, as different people obtain health care through different means. The system has continued to undergo changes, due to concerns related to costs, access to care, and quality outcomes.
As health care expenditures continue to rise due to aging populations and managing chronic diseases, providers, payers, and policymakers must shift their focus from traditional fee-for-service models to value-based care programs. Value-based healthcare is a healthcare delivery model in which providers are paid based on patients’ health outcomes. Under value-based care, providers are paid and rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This model promotes high-value health care, with the best possible outcomes per dollar spent (Agba, et al., 2022).
As the US health care system continues to evolve into value-based healthcare, and providers are incentivized based on patients’ health care outcomes, the demand for mid-level health care practitioners will continue to increase. We are also seeing more healthcare legislation directed towards expanding the scope of practice and roles of advanced practice nurses to be able to practice independently, without direct supervision from a physician, in order to provide much-needed medical care in areas and communities that need them most.
References:
Agba, C. O., Snowden-Bahr, J. D., Kadakia, K., Chaker, S. A., Young, J. B., Forystek A. G., (2022). Global horizons for value-based care: Lessons learned from the Cleveland clinic, NEJM Catalyst 3 (5) https://catalyst.nejm.org/doi/pdf/10.1056/CAT.22.0123
DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning
The Centers for Medicare & Medicaid Services (CMS) released the value-based programs to phase out the fee-for-service program in 2008. Since then, our healthcare system graduates to shift, and the program’s main idea is to eliminate the unnecessary medical cost of healthcare. Paying providers is based on the quality of care, not the quantity. (CMS, 2022) During the shift, we have seen different kinds of legislation passed and programs implemented in our current system, like the Affordable Care Act (ACA), the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Alternative Payment Models, and Merit-Based Incentive Payment System (MIPS). (CMS, 2022)
The MIPS eligible clinicians include Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists. (Mingle Health, 2020) The eligible clinician participating in the quality payment program through MIPS is not required to submit the cost performance; the measurements are calculated based on Medicare Part B, observation or outpatient service, and administrative claims data. The major evolving trend in the healthcare delivery system is that advanced registered nurses will play a role and responsibilities in observation or outpatient care to improve the quality of patient care as the healthcare industry moves toward value-based care. In the future, we may see an increase in advanced registered nurses who practice independently and influence the direction of healthcare.
Reference:
Centers for Medicare & Medicaid Services. (2022, March 31). value-based programs. CMS.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
Mingle Health. (2020, August 13). Mips eligibility: Who must participate, and who is exempt from MIPS participation and reporting? https://minglehealth.com/blog/mips-eligibility-reporting-exemptions/
Access to healthcare is a fundamental human right. The World Health Organization promotes access to healthcare for all and strives to implement initiatives to support this mandate. The WHO states, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (Ghebreyesus, 2017). To support this mandate, I believe that the United States Government should provide access to healthcare and disease prevention programs to all. The current value-based health program for the U.S does not support the WHO mandate. This current U.S. program does not provide healthcare to citizens regardless of their socioeconomic status. This results in a lack of health services for citizens that cannot afford private insurance provided by an employer. According to DeNisco, the value-based system creates free-market conditions resulting in an inverse relationship between price and quantity (2019). This type of market has led to health inequality in the U.S.
The United States has a healthcare system run by privately funded insurance and healthcare administration. No central department of the government oversees all aspects of the health system. Departments such as Medicare and Medicaid help determine public-sector expenditures, reimbursement rates, regulations, and certification standards (DeNisco, 2021). The U.S. health system has resulted in health inequality influenced by socioeconomic factors. Advanced Practice Nurses (APRNs) are pivotal in helping to improve health equity and access to health care. The value-based system has created a greater need for healthcare providers. APRNs have become in high demand due to an increase in the quantity of access to healthcare.
Health care should be affordable and accessible to all; a flaw in our current system is that we have some of the best programs, techniques, and treatments in the world, but it is not accessible to all. If health inequality is not addressed, more and more individuals will continue to create a more significant problem with health disparities. This will place more responsibility on APRNs to support the public health sector and provide resources to those who suffer from health inequality.
References
DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124
Ghebreyesus, T. A. (2017, December 10). Health is a fundamental human right. World Health Organization. Retrieved October 10, 2022, from https://www.who.int/news-room/commentaries/detail/health-is-a-fundamental-human-right
The Affordable Care Act (ACA) has been a driving force in the shift of focus within the healthcare system from fee for service to value-based care. In a value-based care system, providers are reimbursed based on patient outcomes and wellness, rather than how many tests and therapies are prescribed (DeNisco, 2021). The goals of value-based care are to increase quality outcomes and, therefore, improve individual and population health while controlling costs. As the healthcare system goes through this foundational change, there is opportunity for rebuilding the system to better serve its consumers. As Weberg et al. (2019) point out, the success of a healthcare policy depends on its attention on affordability, access to care, quality and patient engagement and experience.
Advanced registered nurses are uniquely qualified to advance value-based care in a number of ways. By utilizing evidenced based research and practice, nurses can adopt and promote the usage of practices that result in better outcomes for patients. This will drive overall improvement of quality within the healthcare system and reduce cost by limiting the use of ineffective practices. Also, by questioning the status quo within the healthcare system, nurses can bring about new and innovative ideas based on their expertise at the point of care to ensure that the practices being utilized are founded in the best and most-current knowledge. In addition, nurses are able to educate their patients to be their own best advocate in seeking and understanding their own care. An educated and engaged patient is more likely to follow care recommendations.
In accordance with value-based care, a shared governance nursing model has evolved. By empowering nurses at all levels to use their voice and experience to promote best practices, the healthcare system benefits from the collective wisdom of nurses. This is a valuable resource that can be integral in improving healthcare at all levels.
The evolution of the American healthcare system will continue for years to come. Deconstructing the old ways of financially incentivizing “more” in terms of ordered tests and treatments and rebuilding the system to value interventions based on their outcomes will take time and creative thinking. Advanced registered nurses have the experience and knowledge to be integral contributors to this process.
DeNisco, S. (2021). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.
Weberg, D. R., Mangold, K., Porter-O’Grady, T., Malloch, K. (2019). Leadership in nursing practice: changing the landscape of health care. Jones & Bartlett Learning.
